Infarct Characteristics by CMR Identifies Substrate for Monomorphic VT in Post‐MI Patients with Relatively Preserved Systolic Function and ns‐VT

Yalın, Kıvanç; Gölcük, Ebru; Buyukbayrak, Hakan; Yılmaz, Ravza; Arslan, Muhammet; Dursun, Memduh; Bilge, Ahmet Kaya; Adalet, Kâmil

doi:10.1111/pace.12289

Cited by 22 publications

(15 citation statements)

References 31 publications

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“…In this study, the core infarct was defined as areas with SI 50% of maximal SI in the hyperenhanced area and the infarct grey zone as myocardium with SI peak SI of remote myocardium but, 50% of the maximum SI (9). In patients with relatively preserved left ventricular functions, we showed that patients with inducible VT have larger peri-infarction zone (10). Inducibility of VTs does not necessarily correlate with the occurrence of spontaneous VTs.…”

Section: Discussionmentioning

confidence: 88%

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No association between scar size and characteristics on T-wave alternans in post-myocardial infarction patients with relatively preserved ventricular function presented with nonsustained ventricular tachycardia

Yalın

Gölcük²,

Teker³

et al. 2014

Anadolu Kardiyol Derg

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Objective: Microvolt T-wave Alternans (TWA) is associated with abnormal repolarization and predicts arrhythmic mortality in patients with previous myocardial infarction (MI). Infarct tissue size and heterogeneity characterized by cardiac magnetic resonance (CMR) has been shown to be associated with arrhythmogenic substrates and sudden cardiac death. Although both delayed enhancement-CMR (de-CMR) and TWA are useful in risk stratification of post-MI patients with preserved left ventricular function, the relationship between scar size and TWA has not studied yet. In this study, we aimed to study the relation between TWA and scar size and characteristics assessed with CMR in post-MI patients (pts) with relatively preserved systolic function presented with nonsustained VT. Methods: This observational cross-sectional study was enrolled 36 post-MI patients with mild-systolic dysfunction and non-sustained ventricular tachycardia. Eight pts were excluded. Both TWA and contrast enhanced CMR were performed. Left ventricular ejection fraction (LVEF), dense scar, peri-infarct zone and total scar masses were assessed and these values to left ventricular (LV) mass ratios were calculated. Infarct ratios and characteristics were determined and compared among patients with negative TWA and those with positive TWA. Results: For the positive (n=12) vs. negative (n=16) TWA patients there were no significant difference between LVEF (44.9±5.4% vs. 44.0±3.2%, p=NS) and LV masses (121.89±26.56 g vs. 106.14±21.16 g, p=NS). The ratio of scar core to LV mass (3.37±0.68% vs. 3.31±1.01%, p=NS), peri-infarct zone to LV mass (23.61±7.93% vs. 21.64±9.08%, p=NS), total scar to LV mass (26.98±7.86% vs. 24.96±9.62%, p=NS) were all similar. Conclusion: There were no association between scar size and infarct heterogeneity and prevelance of TWA in post-MI patients with relatively preserved LVEF with non-sustained VT. Our data suggest that these two modalities may reflect different arrhythmogenic mechanisms in this cohort. (Anadolu Kardiyol Derg 2014; 14: 442-7)

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Section: Discussionmentioning

confidence: 88%

“…These reports showed that extent of the left ventricular scarring as well as the extent of the peri-infarct zone were independent predictors of ventricular tachyarrhythmia induciblity in ischemic cardiomyopathy. Also these scar characteristics have been linked to appropriate ICD shocks in this patient group (6)(7)(8)(9)(10)(11).…”

Section: Introductionmentioning

confidence: 99%

No association between scar size and characteristics on T-wave alternans in post-myocardial infarction patients with relatively preserved ventricular function presented with nonsustained ventricular tachycardia

Yalın

Gölcük²,

Teker³

et al. 2014

Anadolu Kardiyol Derg

Self Cite

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“…The assessment of infarct scar is important also to risk stratify patients according to their risk of arrhythmic events, as it is well known that myocardial scar represents the substrate for re-entrant arrhythmias [ 73 ]. Different studies on patients undergoing CMR prior to ICD implantation have shown that scar extent is stronger than LVEF in predicting arrhythmic events (sudden death, ICD discharge, ventricular arrhythmias) and inducibility at electrophysiologic study (EPS) [ 74 – 76 ] and remains the strongest predictor, also in patients with preserved ejection fraction [ 77 ]. Scar analysis on CMR is based on different signal intensity of the infarcted area as compared to an area of normal, remote myocardium.…”

Section: Risk Stratificationmentioning

confidence: 99%

Role of cardiovascular magnetic resonance in acute and chronic ischemic heart disease

Baritussio

Scatteia

Bucciarelli-Ducci

2017

Int J Cardiovasc Imaging

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Cardiovascular magnetic resonance (CMR) is a multi-parametric, multi-planar, non-invasive imaging technique, which allows accurate determination of biventricular function and precise myocardial tissue characterization in a one-stop-shop technique, free from the use of ionizing radiations. Though CMR has been increasingly applied over the last two decades in every-day clinical practice, its widest application has been in the assessment of ischemic cardiomyopathy.

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“…17,18 More recently, investigators have shown that the extent of peri-infarct zone detected by CMR post AMI correlated with increased ventricular inducibility, even in patients with relatively preserved LVEF. 19…”

Section: Imaging Techniquesmentioning

confidence: 99%

Sudden Cardiac Death Risk Stratification — An Update

Liew

2015

European Cardiology Review

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Sudden cardiac death (SCD) remains a major public health problem worldwide, yet current methods to identify those at greatest risk are inadequate. High-risk individuals may benefit from potentially life-saving treatment, such as insertion of an implantable-cardioverter defibrillator (ICD). However, such treatments are expensive and have their own associated risks. Furthermore, most cases of SCD occur in the general adult population who may be relatively asymptomatic but yet have an underlying predisposition to SCD. Hence, there is great interest and clinical need in improving methods for risk stratification of SCD to identify those at greatest risk and implement the most appropriate treatment. This review provides an update on current risk-stratification methods for SCD in high-risk groups, in particular patients with reduced left ventricular function following acute myocardial infarction and those with non-ischaemic dilated cardiomyopathy, and highlights some novel methods that may have a role to play in future risk-stratification schemes. Approaches and challenges for SCD risk stratification among the general public are also discussed.

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Infarct Characteristics by CMR Identifies Substrate for Monomorphic VT in Post‐MI Patients with Relatively Preserved Systolic Function and ns‐VT

Abstract: Higher PIZ percent and TS percent were correlated with increased ventricular inducibility. These data support the hypothesis that ce-CMR may be used to identify the substrate for ventricular arrhythmia in this cohort.

Cited by 22 publications

References 31 publications

No association between scar size and characteristics on T-wave alternans in post-myocardial infarction patients with relatively preserved ventricular function presented with nonsustained ventricular tachycardia

No association between scar size and characteristics on T-wave alternans in post-myocardial infarction patients with relatively preserved ventricular function presented with nonsustained ventricular tachycardia

Role of cardiovascular magnetic resonance in acute and chronic ischemic heart disease

Sudden Cardiac Death Risk Stratification — An Update

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